Organization
KJ ADULT CARE ,LLC
Active
Other names
KJ Adult Care, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
TRACIE RENEE CHISLOM (OWNER)
(678) 557-2613
Entity
Organization
Contact information
Practice address
1002 W SOLOMON ST, GRIFFIN, GA 30223-2632
(678) 557-2613
(678) 572-4514
Mailing address
1002 W SOLOMON ST, GRIFFIN, GA 30223-2632
(678) 557-2613
(678) 572-4514
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1801354774
—
GA
Enumeration date
06/11/2020
Last updated
06/11/2020
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